역동적 조영증강 자기공명영상의 지연기 영상에서 간 실질의 조영증강 양상: Gd-EOB-DTPA와 Gd-DTPA-BMA의 비교 = Enhancement Pattern of Liver Parenchyma during Late Dynamic Phase Imaging: Comparison between Gd-EOB-DTPA and Gd-DTPA-BMA

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the differences in enhancement patterns of liver parenchyma during the late dynamic phase imaging between gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA) and gadolinium-diethylenetriamine-pentaacetic acid-bismethylamide (Gd-DTPA-BMA).
Materials and Methods: 130 patients (88 men and 42 women at the mean age of 59.4 years) and 110 patients (72 men and 38 women at the mean age of 60.2 years) underwent dynamic contrast-enhanced MR imaging, using Gd-EOB-DTPA and Gd-DTPA-BMA, respectively, at 3T MR scanner. In both groups, the patients were divided into three categories: category I for normal liver, category II for Child A cirrhotic liver, and category III for Child B and C cirrhotic liver. Late dynamic phase scanning was performed at 100, 140, and 180 seconds after injection of the contrast agent. The injected dose of Gd-EOB-DTPA and Gd-DTPA-BMA was 0.025 mmol/kg of the body weight and 0.1 mmol/kg of the body weight, respectively. Signal intensity ratio of the liver (SIRL), contrast ratio between liver and portal vein (LPC), and contrast ratio between liver and spleen (LSC) were calculated and compared between Gd-EOB-DTPA group and Gd-DTPA-BMA group according to the scan delay time.
Results: There was no statistically significant difference between the two groups in respect to demographic characteristics. SIRL of Gd-EOB-DTPA group was significantly lower at 100 seconds in category I, and also at 100 and 140 seconds in category II (p < 0.05). In Gd-EOB-DTPA group, LPC and LSC showed an increasing trend according to the delayed time in all of the categories. In Gd-DTPA-BMA group, LPC and LSC showed similar values according to the delayed time in all of the categories. LPC of Gd-EOB-DTPA group was significantly higher at 100, 140, and 180 seconds in category I and II (p < 0.05). LSC of Gd-EOB-DTPA group was significantly higher at 100, 140, and 180 seconds in category I, II, and III (p < 0.05).
Conclusion: In contrast to Gd-DTPA-BMA, the late phase imaging using Gd-EOB-DTPA was affected by intracellular distribution of the contrast agent, which was proportional to the elapsed time after the injection of Gd-EOB-DTPA.

국문 초록 (Abstract)

목적: Gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (이하 Gd-EOB-DTPA)와 gadolinium-diethyl-enetriamine-pentaacetic acid-bismethylamide (이하 Gd-DTPA-BMA)를 이용한 역동적 조영증강 자기공명영상의 지연기 영상에서 간 실질의 조영증강 양상을 비교 분석하고자 하였다.
대상과 방법: 3 Tesla 자기공명영상기기에서 각각 Gd-EOB-DTPA와 Gd-DTPA-BMA를 사용하여 역동적 조영증강 자기공명영상을 시행 받은 130명(남자: 88명, 여자: 42명; 평균 연령: 59.4세)과 110명(남자: 72명, 여자: 38명; 평균 연령: 60.2세)의 환자들을 대상으로 하였다. 각각의 환자군은 Child-Pugh 등급에 의해 세 군으로 나누었다(I군: 정상, II군: Child-Pugh 등급 A 간경변, III군: Child-Pugh 등급 B 또는 C 간경변). 지연기 영상은 조영제 주입 후 100초, 140초, 그리고 180초에 각각 시행하였다. Gd-EOB-DTPA와 Gd-DTPA-BMA의 주입 용량은 각각 0.025 mmol/kg과 0.1 mmol/kg으로 하였다. Gd-EOB-DTPA와 Gd-DTPA-BMA 환자군에서 시간에 따른 간 실질의 신호강도 비(signal intensity ratio of the liver; 이하 SIRL), 간문맥과 비교한 간 실질의 상대적인 신호강도(contrast ratio between liver and portal vein; 이하 LPC), 비장과 비교한 간 실질의 상대적인 신호강도(contrast ratio between liver and spleen; 이하 LSC)를 구한 후 비교하였다.
결과: Gd-EOB-DTPA와 Gd-DTPA-BMA 환자군 사이에 환자의 나이, 성별, 간 기능의 분포는 통계학적으로 차이가 없었다. SIRL값은 I군의 100초, II군의 100초와 140초 지연기 영상에서 Gd-EOB-DTPA 환자군이 Gd-DTPA-BMA 환자군보다 유의하게 낮은 값을 보였다(p ＜ 0.05). LPC와 LSC값은 Gd-EOB-DTPA 환자군의 모든 군에서 시간이 지날수록 증가하는 양상을 보였다. Gd-DTPA-BMA 환자군은 모든 군에서 시간이 지나도 비슷한 값을 보였다. LPC값은 I군과 II군의 100초, 140초, 180초 지연기 영상에서 Gd-EOB-DTPA 환자군이 Gd-DTPA-BMA 환자군보다 유의하게 높은 값을 보였다(p ＜ 0.05). LSC값은 모든 군의 100초, 140초, 180초 지연기 영상에서 Gd-EOB-DTPA 환자군이 Gd-DTPA-BMA 환자군보다 유의하게 높은 값을 보였다(p ＜ 0.05).
결론: Gd-EOB-DTPA를 이용한 지연기 영상은 Gd-DTPA-BMA에서는 관찰할 수 없는 조영제의 간세포 내 분포에 영향을 받으며, 조영제 주입 후 시간이 지날수록 그 영향이 점차 커진다.

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